Abstract
Purpose
This study aims to evaluate the proximity of the tendon stripper to both the peroneal and sural nerves during peroneus longus tendon (PLT) autograft harvesting.
Methods
Ten fresh–frozen human cadaveric lower extremities were used to harvest a full-thickness PLT autograft using a standard closed blunt-ended tendon stripper. The distance to the sural nerve from the PLT (at 0, 1, 2 and 3 cm proximal to lateral malleolus (LM), and the distance to the peroneal nerve and its branches from the end of the tendon stripper were measured by two separate observers using ImageJ software.
Results
The average distance from the PLT to the sural nerve increased significantly from 0 to 2 cm proximal to LM. The average distance to the sural nerve at the LM was 4.9 ± 1.5 mm and increased to 10.8 ± 2.4 mm (2 cm proximal to LM). The average distance from the tendon stripper to the deep peroneal nerve was 52.9 ± 11.4 mm. The average distance to the PLT branch of peroneal nerve was 29.3 ± 4.2 mm. The superficial peroneal nerve, which coursed parallel and deep to the tendon stripper, was on average 5.2 ± 0.7 mm from the end of the stripper. No transection injuries of the nerves were observed in any of the ten legs after harvesting.
Conclusion
This cadaver study found during a full-thickness PLT harvest, the distances between the tendon stripper and the nerves were greater than 5 mm with an initial incision at 2 cm proximal to LM which is recommended.
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Abbreviations
- ACL:
-
Anterior cruciate ligament
- PLT:
-
Peroneus longus tendon
- LM:
-
Lateral malleolus
- PBT:
-
Peroneus brevis tendon
- ICC:
-
Intraclass correlation coefficient
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Acknowledgements
The authors appreciate Dr. Caiqi Xu and Dr. Feng Qu discussing the procedure among harvesting peroneus longus tendon autograft.
Funding
JH is a visiting scholar and supported by the program of China Scholarships Council and the National Natural Science Foundation of China (No. 81802208).
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JH performed the dissection of cadavers and the collection of all data. KB, HU and RK assisted in the dissection of cadavers and collection of all data. JH, KB and ML drafted and edited the original manuscript. JH, ML, PS, SW and FF participated in the conception and design of the original study. All the authors read and approved the final manuscript.
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The authors declare no conflicts of interest.
Ethical approval
Approval for this study and use of cadaver specimens was obtained from the University of Pittsburgh Committee for Oversight of Research and Clinical Training Involving Decedents (CORID #453).
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No informed consent was required for this study.
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Investigation performed at the Department of Orthopaedics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Supplementary Information
Below is the link to the electronic supplementary material.
167_2021_6698_MOESM1_ESM.tif
Supplementary Fig. 1 Photographed step. 1 of peroneus longus tendon (PLT) harvest. The left suture with white and light blue was used to mark the proximal part of PLT, the right suture with deep blue was used to mark the distal segment of PLT. The PLT was transected between the two sutures (TIF 26640 KB)
167_2021_6698_MOESM2_ESM.tif
Supplementary Fig. 2 Photographed step. 2 of peroneus longus tendon (PLT) harvest. PLT was transected, and the posterior tendon with white and light blue suture was the PLT autograft. The anterior tendon was the peroneus brevis tendon stitched with distal segment of PLT marked with blue suture to preserve the function of PLT (TIF 24892 KB)
167_2021_6698_MOESM3_ESM.tif
Supplementary Fig. 3 Double-check of peroneus longus tendon (PLT) harvest. PLT autograft had been harvested, and the distal lateral compartment of ankle was exposed to visualize the end point of peroneus brevis tendon (PBT). The PBT is intact, and the proximal part of PLT was harvested. It is important to not accidentally harvest the PBT instead of PLT (TIF 36208 KB)
167_2021_6698_MOESM4_ESM.tif
Supplementary Fig. 4 Peroneus longus tendon (PLT) autograft preparation. PLT was prepared with double-strand and measured with graft sizer (8.5 mm in diameter) (TIF 4642 KB)
Supplementary Video 1 Captured steps of peroneus longus tendon harvest (MP4 13276 KB)
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He, J., Byrne, K., Ueki, H. et al. Low to moderate risk of nerve damage during peroneus longus tendon autograft harvest. Knee Surg Sports Traumatol Arthrosc 30, 109–115 (2022). https://doi.org/10.1007/s00167-021-06698-2
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DOI: https://doi.org/10.1007/s00167-021-06698-2